Mucoid Degeneration of the Anterior Cruciate Ligament
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Published:
May 7, 2013
Keywords:
Anterior cruciate ligament, Mucoid degeneration, Arthroscopic debridement, Intercondylar notch widening.
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Abstract
BackgroundThe purpose of this study is to perform a systematic literature review of the ACL mucoid and describe our experience in the diagnosis and surgical treatment of this pathology.MethodsWe describe the clinical features, the pathophysiology, the imaging findings and surgical treatment of this condition. Furthermore we present a retrospective study performed between 2004 and 2011 including 27 patients (average age 55 years; range: 34-68 years). Pain, range of motion and stability were taken into account in the evaluation of patients. Clinical maneuvers and KT-1000 test were used to assess post-surgical stability. X-rays and MRI were performed before and after surgery. Post-surgical results were evaluated using the Lysholm score, IKDC and with the visual analogue scale. Samples were taken for biopsies.ResultsVisual analogue scale improved 6 points (max 8- min 2). Mobility range improved an average of 26º. Knee stability was not affected. As regards the functional evaluation, final IKDC was A in 50% of patients, B in 33% and C in 17%. Lysholm score was 95 points. Results in the subjective rating scale ranged from very good to excellent in most patients. There were no post-surgical complications.ConclusionsMRI is the best imaging technique for diagnosis. Findings are characteristic and should not be confused with ACL tears. Final diagnosis is histological. We believe that the arthroscopic treatment is effective and with a low incidence of complications.
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How to Cite
Bonifacio, J. P., Carbo, L., Yacuzzi, C., Astoul, J., Costa Paz, M., & Muscolo, L. D. (2013). Mucoid Degeneration of the Anterior Cruciate Ligament. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(1), 5-12. https://doi.org/10.15417/116
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Clinical Research
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References
1. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin S. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Arthroscopy 2008;24(6):642-9.
2. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. J Bone Joint Surg Br 1999;81(2):304-5.
3. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthopaedics & Traumatology: Surgery & Research 2010;96(4):400-6.
4. Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surg Sports Traumatol Arthrosc 2011;19:408-11.
5. Lysholm J, Gilquist J. Evaluation of the knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10:150-154.
6. Rossi MJ, Lubowitz JH, Guttmann D. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2002;30:152.
7. Irrgang JJ, Ho H, Harner CD, Fu HF. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998;6:107-114.
8. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;(198):43-9.
9. Hsu CJ, Wang SC, Fong YC, Fong YC, Huang CY, Chiang IP et. al. Mucoid degeneration of the anterior cruciate ligament. J Chinese Med Assoc 2006;69(9):449-52.
10. Melloni P, Valls R, Yuguero M, Sáez A. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle. Skeletal Radiol 2004;33(6):359-62.
11. Nishimori M, Sumen Y, Sakaridani K. Mucoid degeneration of the anterior cruciate ligament-a report of two cases. Magn Reson Imaging 2004;22(9):1325-8.
12. Niki Y, Matsumoto H, Enomoto H, Toyama Y, Suda Y. Mucoid degeneration of the anterior cruciate ligament associated with subclinical instability in young patients. J Orthop Sci 2010;15(2):251-6.
13. Holder J, Haghighi P, Trudeil D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. Am J Roentgenol 1992;159:357-60.
14. Scranton PE, Farrar EL. Mucoid degeneration of the patellar ligament in athletes. J Bone Joint Surg 1992;74(3):435-437.
15. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. Am J Roentgenol 2004;182:1283-7.
16. Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004;20(2):141-6.
17. Salvati F, Rossi F, Limbucci N, Salvati F, Rossi F, Limbucci N, et al. Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness 2008;48(4):483-7.
18. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011;19(8):1326-33.
19. Fernandes JL, Viana SL, Mendonça JLF, Freitas FMO. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta Radiologica 2008;49(1):75-9.
20. Cha JH, Lee SH, Shin MJ, Choi BK, Bin SL. Relationship between mucoid hypertrophy of the anterior cruciate ligament and morphologic change of the intercondylar notch: MRI and artrhroscopy correlation. Skeletal Radiol 2008;(9):821-6.
21. Motmans R, Verheyden F. Mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009;17(7):737-40.
22. Fealy S, Kenter K, Dines J, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2001;17(9):37-39.
23. Hensen JJ, Coerkamp EG, Bloem JL, De Schepper M. Mucoid degeneration of the anterior cruciate ligament. JBR-BTR 2007;90(3):192-3.
24. McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Skeletal Radiol 2001;30(6):312-5.
25. Viana SL, Fernandes JL, Mendonça JL. Diffuse intrasubstance signal abnormalities of the posterior cruciate ligament: The counterpart of the mucoide degeneration of the anterior cruciate ligament? A case series. JBR-BTR 2008;91(6):245-8.
2. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. J Bone Joint Surg Br 1999;81(2):304-5.
3. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthopaedics & Traumatology: Surgery & Research 2010;96(4):400-6.
4. Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surg Sports Traumatol Arthrosc 2011;19:408-11.
5. Lysholm J, Gilquist J. Evaluation of the knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10:150-154.
6. Rossi MJ, Lubowitz JH, Guttmann D. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2002;30:152.
7. Irrgang JJ, Ho H, Harner CD, Fu HF. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998;6:107-114.
8. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;(198):43-9.
9. Hsu CJ, Wang SC, Fong YC, Fong YC, Huang CY, Chiang IP et. al. Mucoid degeneration of the anterior cruciate ligament. J Chinese Med Assoc 2006;69(9):449-52.
10. Melloni P, Valls R, Yuguero M, Sáez A. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle. Skeletal Radiol 2004;33(6):359-62.
11. Nishimori M, Sumen Y, Sakaridani K. Mucoid degeneration of the anterior cruciate ligament-a report of two cases. Magn Reson Imaging 2004;22(9):1325-8.
12. Niki Y, Matsumoto H, Enomoto H, Toyama Y, Suda Y. Mucoid degeneration of the anterior cruciate ligament associated with subclinical instability in young patients. J Orthop Sci 2010;15(2):251-6.
13. Holder J, Haghighi P, Trudeil D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. Am J Roentgenol 1992;159:357-60.
14. Scranton PE, Farrar EL. Mucoid degeneration of the patellar ligament in athletes. J Bone Joint Surg 1992;74(3):435-437.
15. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. Am J Roentgenol 2004;182:1283-7.
16. Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004;20(2):141-6.
17. Salvati F, Rossi F, Limbucci N, Salvati F, Rossi F, Limbucci N, et al. Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness 2008;48(4):483-7.
18. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011;19(8):1326-33.
19. Fernandes JL, Viana SL, Mendonça JLF, Freitas FMO. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta Radiologica 2008;49(1):75-9.
20. Cha JH, Lee SH, Shin MJ, Choi BK, Bin SL. Relationship between mucoid hypertrophy of the anterior cruciate ligament and morphologic change of the intercondylar notch: MRI and artrhroscopy correlation. Skeletal Radiol 2008;(9):821-6.
21. Motmans R, Verheyden F. Mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009;17(7):737-40.
22. Fealy S, Kenter K, Dines J, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2001;17(9):37-39.
23. Hensen JJ, Coerkamp EG, Bloem JL, De Schepper M. Mucoid degeneration of the anterior cruciate ligament. JBR-BTR 2007;90(3):192-3.
24. McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Skeletal Radiol 2001;30(6):312-5.
25. Viana SL, Fernandes JL, Mendonça JL. Diffuse intrasubstance signal abnormalities of the posterior cruciate ligament: The counterpart of the mucoide degeneration of the anterior cruciate ligament? A case series. JBR-BTR 2008;91(6):245-8.